UNICEF Horn of Africa Measles Outbreak Humanitarian Situation Report, 17 May 2017
SITUATION IN NUMBERS
7,400 Children with measles in drought affected areas of Ethiopia, Kenya and Somalia (Source: WHO and UNICEF Ethiopia, Kenya and Somalia)
3.4 million Children (under five years) at high risk of measles in drought affected areas of Ethiopia, Kenya and Somalia (Source: UNICEF Ethiopia, Kenya, Somalia)
UNICEF funding requirements for health in emergencies * US$ 40.2 million *The above total reflects the health sector requirements against the Humanitarian Action for Children appeals for Ethiopia, Kenya and Somalia.
Due to the ongoing drought in the Horn Africa almost 3.4 million children under five are now at a high risk of contracting measles in the drought-affected areas of Ethiopia, Kenya and Somalia.
Almost 7,400 cases have been reported among children in the drought affected areas of the three countries. Somalia reports the highest figure, over 7,000 cases since beginning of 2017, compared to 5,657 for the entire 2016.
In Somalia, a phased integrated measles and Vitamin A hotspots response campaign was launched in April 2017. The first phase is now completed with 252,827 children vaccinated in 12 hot spot districts in Somaliland.
The funding requirement for the health response in emergencies for Ethiopia, Kenya and Somalia is US$ 40.2 million with a funding gap of 28 per cent.
Situation Overview and Humanitarian Needs
Measles outbreaks have now being reported in three drought-affected countries in the Horn of Africa, including Ethiopia (3481 cases), Kenya (11 cases) and Somalia (7,031 cases).
In Ethiopia, 348 cases had been confirmed and 40 outbreaks reported in Addis Ababa, Afar, Amhara, Oromia, Southern Nations Nationalities and Peoples, Somali and Tigray regions, as of 31 March 2017. The majority of the cases (39 per cent) have occurred among children under five years. Although not yet officially confirmed by the Federal Ministry of Health (FMOH), over 100 cases of measles were additionally reported during the month of April 2017 in Gashamo Woreda, Jarar zone, in Somali region, which would bring total number of cases in 2017 to approximately 450 cases. The Somali region is particularly prone to disasters, and is disproportionately affected by the current drought with high levels of food insecurity, severe acute malnutrition, and acute water shortages as well as significant internal displacement. The high rates of acute malnutrition have increased the vulnerability of local communities to communicable disease outbreaks, including measles and acute watery diarrhoea. A risk analysis conducted in Somali region by UNICEF, the Somali Regional Health Bureau and partners in late April identified five priority zones affected by the complex emergency, including Jarar, Karahey, Nogob, Erer and Dolo.
In Kenya, an outbreak of measles was declared in Dadaab refugee camp, which currently accommodates as estimated 250,000 refugees from Somalia. The first suspected cases were reported on 1 April in Dagahaley camp among two siblings who arrived in the camp with their parents a few weeks before from Saakow district in Jubbaland State, Somalia, bordering Garissa County. A further three confirmed cases were recorded among children newly arrived in IFO camp. Thirteen cases of measles have now been reported up until 2 May, of which five are confirmed cases. No deaths have yet been reported. All affected children are new arrivals from Somalia aged under five. Sixty-nine per cent of overall reported cases have unknown vaccination status. Risk analysis undertaken by the Minister of Health (MOH) in late April in Dadaab camp shows high routine vaccination coverage at 95 per cent, while the coverage in host community is less than 60 per cent. The sub-county that hosts the refugee camp has a weak surveillance network and high staff turnover, hence there is a strong likelihood of measles may spread to areas adjacent to camps.
The continued movement of populations from Somalia, where there is an ongoing cholera and measles outbreak, to Kenya also further increases the risk of spread of measles within the camp and its surrounding communities.
In Somalia, there have been 7,031 suspected cases of measles reported since the beginning of 2017. This figure exceeds the total number of cases for the whole of 2016 (5,657). More than half of the reported cases are from the central and southern regions, with children (under-5) accounting for 65 per cent of the cases. The top five affected regions are: Banadir, Toghdeer, Lower Shabelle, Sool and Sahil. Measles surveillance is constrained because of its dependence on the polio workforce. Additionally, limited technical logistic laboratory capacities limit the timely availability of laboratory confirmation of measles outbreaks.
All outbreak countries report low first dose coverage of measles at national level, with large disparities between regions and with pockets of low immunity. While a measles campaign is being organized in Somalia, there are delays in rolling out similar campaigns in Kenya and in Ethiopia, particularly in Ethiopia’s Somali region due to the rapid spread of acute watery diarrhoea. To prevent further expansion of the disease outbreak in Somalia, UNICEF and partners are exploring ways to vaccinate children arriving into both Ethiopia and Kenya from Somalia. However, challenges remain as some families are not being registered for fear of being sent home.